It’s time for another remedial history lesson. Today’s subject will be epidemics. I have decided not to make any editorial comment regarding this subject. Instead, I will use excerpts from Wikipedia to tell the story. The link to each related article is at the bottom of each section. Please, take the time to read the Wikipedia posts. This is important information that concerns everybody.

Spanish Influenza Epidemic

The 1918 flu pandemic (January 1918 – December 1920) was an unusually deadly influenza pandemic, the first of the two pandemics involving H1N1 influenza virus. It infected 500 million people across the world, including remote Pacific islands and the Arctic, and killed 50 to 100 million of them—three to five percent of the world’s population—making it one of the deadliest natural disasters in human history.

A large factor in the worldwide occurrence of this flu was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease.

To maintain morale, wartime censors minimized early reports of illness and mortality in Germany, Britain, France, and the United States; but papers were free to report the epidemic’s effects in neutral Spain (such as the grave illness of King Alfonso XIII), creating a false impression of Spain as especially hard hit—thus the pandemic’s nickname Spanish flu.

Influenza may have killed as many as 25 million people in its first 25 weeks. Older estimates say it killed 40–50 million people, while current estimates say 50–100 million people worldwide were killed. It is said that this flu killed more people in 24 weeks than AIDS has killed in 24 years, more in a year than the Black Death killed in a century.

This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. Symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, “One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred.” The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.

Even in areas where mortality was low, so many were incapacitated that much of everyday life was hampered. Some communities closed all stores or required customers to leave orders outside. There were reports that the health-care workers could not tend the sick nor the gravediggers bury the dead because they too were ill. Mass graves were dug by steam shovel and bodies buried without coffins in many places.

In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck. In the Pacific, American Samoa and the French colony of New Caledonia also succeeded in preventing even a single death from influenza through effective quarantines.

In the United States, the United Kingdom and other countries, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918–1919, the Spanish flu began to fade from public awareness over the decades until the arrival of news about bird flu and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a “forgotten pandemic”.

Ebola virus disease (EVD), Ebola hemorrhagic fever (EHF) or simply Ebola is a disease of humans and other mammals caused by an ebolavirus. Symptoms start two days to three weeks after contracting the virus, with a fever, sore throat, muscle pain and headaches. Typically, vomiting, diarrhea and rash follow, along with decreased function of the liver and kidneys. Around this time, affected people may begin to bleed both within the body and externally.

The current epidemic of EVD, caused by Ebola virus, is the most severe outbreak of Ebola since the finding of ebolaviruses in 1976, and by September 2014 cases of EVD from this single outbreak exceeded the sum of all previously identified cases.The epidemic has caused significant mortality, with a Case Fatality Rate reported as 71%.

By the end of August, the WHO reported that the loss of so many health workers was making it difficult for them to provide sufficient numbers of foreign medical staff. The Director-General of the WHO, Margaret Chan, called the outbreak “the largest, most complex and most severe we’ve ever seen” and said that it “is racing ahead of control efforts”. In a 26 September statement, the WHO said, “The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times.”

One of the primary reasons for spread is that the health systems in the part of Africa where the disease occurs function poorly. The risk of transmission is increased among those caring for people infected. Recommended measures when caring for those who are infected include medical isolation via the proper use of boots, gowns, gloves, masks and goggles, and sterilizing equipment and surfaces. However, even with proper isolation equipment available, working conditions such as no running water, no climate control, and no floors, may continue to make direct care more difficult.

Other difficulties faced in attempting to contain the outbreak include the outbreak’s multiple locations across country borders. Dr. Peter Piot, the scientist who co-discovered the Ebola virus, has stated that the present outbreak is not following its usual linear patterns as mapped out in previous outbreaks. This time the virus is “hopping” all over the West African epidemic region. Furthermore, past epidemics have occurred in remote regions, but this outbreak has spread to large urban areas, which has increased the number of contacts an infected person may have and has also made transmission harder to track and break.

In order to reduce the spread, the World Health Organization recommends raising community awareness of the risk factors for Ebola infection and the protective measures individuals can take. These include avoiding contact with infected people and regular hand washing using soap and water. A condition of dire poverty exists in many of the areas that have experienced a high incidence of infections. According to the director of the NGO Plan International in Guinea, “The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink.”

Denial in some affected countries has often made containment efforts difficult. Language barriers and the appearance of medical teams in protective suits has sometimes increased fears of the virus. There are reports that some people believe that the disease is caused by sorcery and that doctors are killing patients. In late July, the former Liberian health minister, Peter Coleman, stated that “people don’t seem to believe anything the government now says.”